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PE�MIT APPLICATION <br /> CITY OF EVEkETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—wuvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SITE ADDRESS PdRCEL TAX I.D.# P RMIT# <br /> 7 3 oos936��go �20° ��odl -�.5 <br /> I LEGAL LOTNO. BLOCK TRACT <br /> DESC. (,_W ��d- 13 6 3 � <br /> OWNER ADDRESS CITY2IP PHONE <br /> �en �or�r5 /9/9 �c,,ckt< f�ve Cv�re� �/ 9�l �y��� /� <br /> TENANTNAME CONTACTFORPERMIi PHONE <br /> Ku, /l�or���s ��/X) �/,zz-2�1N <br /> CONTRACTOR� ��n� j���� /'/�/�S�DR§�� PD .� i9�-'J CITY2IP ��t�PHONE y1S- ?St-4(/0 <br /> � y yP„�o6 <br /> CONTR.LICEN�E# A_/vG��� 6 y�,CM <br /> ii G� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> , Electric Gas_Olher ,S� �O� <br /> WO^'( SCRIPTION � o ���7ti UN/��T2 Z/3 — <br /> ���`e�c � j��yqge , i ��� rl�L`' v ��L <br /> PLUMBING ECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7�RE OR ITEM <br /> ;2� Toilet _ FVC–air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) � ^ �C Gas pipino ) <br /> Shower � �� _ Water healer �' <br /> Kitchen sink 8 disposal � _ _ Gas fireplace � <br /> _ Dishwasher � ( (� '/L�C- Gas range / ` <br /> �lothes washer � / � _ Clothes dryer L�'� <br /> Walerheater j)�� rC'��,-�c�^ � Range hood <br /> x Sink(service/badmop/e 1 , I _ Exhausl fau <br /> Backflow preventer ��(,�_�; ,ZAv CL�� ��ti�� i Heal pump <br /> _ Urinal _���' ?_ ,('�j � i J� Boi ehealer <br /> Drinkinc� Fountain , <br /> xc Floordrain Refrigeration <br /> Grease lrap Woodstove <br /> �';,! Roof drains - ;--� _ Olher <br /> Other � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y thal I have read and examined lhis application and know the same to be true and correct. AI�provisions of laws and <br /> ordinaces goveminc�this type of work will be complied with whether speci(ed herein or not.The granting of a permit does nol presume <br /> lo give aulhonty lo violate or cance�lhe provision of any other state or local law regulating conslruclion or the periormance ot <br /> consiruclion.Thal I am aulhorized by lhe owner of this property lo perform the work for which applicalion is made and I comply with the <br /> Stale Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> �—"� �-,- / z o d <br /> Signat�o(Own dConiractor/Aulhorized Agenl DaCe ��,Z <br />